Blood test, basic metabolic panel
Facility: Regional Medical Center
Billing Code: 80048 (CPT)
- CPT Billing Code: 80048
- Insurance Median: $870
- Cash Discount Price: $80
- vs. Medicare Baseline: 102.84x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $8.46 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 10284% of the Medicare baseline (a markup of 10184%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 10284% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important takeaway is that self-pay rates can often be significantly lower than insurance negotiated rates, making upfront payment the most cost-effective option for this service. The cash price for this blood test and basic metabolic panel is $80, which is notably lower than the $870 negotiated rate paid by Medical Associates Health Plan - Tri. Because insurance contracts often include administrative overhead and multi-layered pricing structures, the cash price can serve as a benchmark for patients with high deductibles or those seeking to minimize out-of-pocket expenses. We strongly recommend asking the hospital staff about "self-pay" or "prompt-pay" discounts before scheduling, as these programs may offer additional reductions for immediate payment.
This procedure is performed at Regional Medical Center in Manchester, Iowa, a Critical Access Hospital owned by the local government. While the cash rate of $80 is accessible to all patients, it is important to understand that commercial insurance rates frequently exceed these cash prices due to the administrative costs and contract dynamics involved in billing. In this specific case, the facility's negotiated rate of $870 is substantially higher than the cash amount, illustrating how in-network contracts can sometimes result in higher costs for insured patients compared to those paying directly. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network emergency care at in-network facilities, it does not automatically prevent higher costs for routine, shoppable services like this lab test when insurance is used.